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Claw Toe
synonyms:
Claw Toe ICD-9
- 735.5 (claw toe, acquired)
Claw Toe Etiology / Epidemiology / Natural History
- Flexion at both the DIP and PIP joints. MP joint extension
- MTP hyperextension is the primary pathology
- high-heeled shoes hold toes in chronic extension allowing long flexors to overpull PIP and DIP joints
- must r/o neuromuscular disease if all 4 lessor toes affected. (e.g., Charcot-Marie-Tooth disease, Friedrich’s ataxia, myelodysplasia, cerebral palsy, multiple sclerosis, stroke)
Claw Toe Anatomy
- EDL can extend the PIP and DIP joints only if the MTP joint is in neutral of slightly flexed position
- chronic hyperextension from high-heeled shoes>>attritional insufficiency of plantar plate>>base of prox phalanyx translates dorsally>>>interossei lumbricals translate dorsally>>>no primary flexion force on MTP
Claw Toe Clinical Evaluation
- Assess MTP hyperextension, plantar displacement of the metatarsal heads and distal migration of the fat pad.
- Evaluate for plantar keratotic lesions
- Assees PIP joint for hyperflexion deformity (hammer toe)
- DIP joint may be flexed, extended, or neutral.
- Flexible claw toe: deformity disappears when the ankle is dorsiflexed and deformity can be reduced or eliminated by application of dorsally directed pressure on the plantar metatarsal heads.
- Fixed claw toe: deformity unchaged with ankle dorsflexion and cannot be reduced or eliminated by application of dorsally directed pressure on the plantar metatarsal heads.
Claw Toe Diagnositc Tests
- A/P, lateral and oblique views of foot.
Claw Toe Classification / Treatment
- Flexible: extra-depth shoe with a toe box that has a soft upper portion. Pad any callosities. Consider taping and strapping flexible deformities. If fails non-operative management ment consider flexor tendon transfer, with/without release of the metatarsophalangeal joint capsule and extensor tenotomies.
- Fixed: extra-depth shoe with a toe box that has a soft upper portion. Pad any callosities. If fails non-operative management consider flexor digitorum longus tenotomy/transfer and a resection of the distal portion of the proximal phalanx to obtain correction (DuVries resection arthroplasty).
Claw Toe Associated Injuries / Differential Diagnosis
Claw Toe Complications
Claw Toe Follow-up Care
Claw Toe Review References
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